Sub:- Provisional Selection of Candidate(S) for Admission in Class

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Ref: - No. 3-20/JNVS/2017-18/ Date: 24.06.2017

To,

______

Sub:- Provisional selection of candidate(s) for admission in class

“VI” for 2017-18-Reg.

Sir/Madam,

With reference to the above, it is to inform that, on the basis of JNV Selection Test-2017 conducted on 08.01.2017 by NVS, Your Son/Daughter______Roll No.______has been provisionally selected for admission subject to the fulfillment of required conditions of JNV District Mandya. You are requested to report to the undersigned with the candidate on 07.07.2017 for verification(s).Office Timings (09.00 am to 4.00 pm).

Please find herewith enclosed the Bio-data sheet to be filled in with the help of the Head Master(s) School concerned from which the candidate has passed class III,IV,V. Kindly ensure that the filled proforma should be singed by the Parent/guardian of the student concerned and countersigned by the Head Master(s) of the school concerned. Further you are instructed to bring the following documents duly completed before admission for verification.

Bio-data sheet duly filled in and signed by the Parent/guardian and countersigned by the Head Master(s) of the schools concerned of the candidate passed class V.
Study certificate and Marks statements(Marks cards) of class III,IV,V
Caste certificate from the competent authority in case of SC/ST/OBC inOriginal along with a xerox copy.
Medical Certificate from the District Medical Officer, MandyaDistrict. In case selected under “PH” quota,Physically Handicapped certificate (In original) is to submitted for verification.
Rural Certificate from the competent authority i.e. from the BEO of concerned Taluk wherever the candidate has studied class III.IV,V in case selected under RURAL quota.
Residence Certificate from the competent authority, original along with Xerox copy(format enclosed).
Socio Economic status (Format enclosed).
Xerox Copy of Aaadhar Card.

You are advised not to obtain TC from the school till all the verification formalities are completed and you are asked to produce. In case you are not interested to admit your ward kindly inform the undersigned in writing the reasons(s) for not admitting your ward in JNV.

Yours faithfully,

(Dr.E.UMAPATHI REDDY)

PRINCIPAL.

Encl:a/a

BIO – DATA

(To be filled by the Parent of the candidate with the help of the Head Master/Mistress of the school from where the child has passed class V Examination)

1. Name of the Candidate ______

2. Sex : Male/Female

3. a)Category : GEN SC ST OBC

b)Caste :______

4. Date of birth (in figures) :______

in words :______

5. Fathers name :______

6. Name of the guardian & :______

Relationship with him/her

In case father is not the

Guardian

7. Mother tongue :______

8. School(s) from where the candidate passed class III & IV and is studying in class V

CLASSES
III / IV / V
a)(i)Month & Year of joining
(ii)Month & year of passing
b)(i)Name of the School
(ii)Is it a recognized school(Yes or No)
c)Name of the village or town (In which the school is located)
d)(i)Name of the Block
e)(i)Name of the district
f)Whether the school is located in Rural/Urban(Write RURAL or URBAN)

CERTIFICATE

(BY PARENT/GUARDIAN OF THE CANDIDATE)

Certified that the information given above is true to the best of my knowledge and belief. In case, any part of the information furnished concealed, I am ready to produce relevant certificate issued by competent authorities and when asked for.

Signature of Parent/ guardian.

Entries verified and certified and

Found correct

Signature of the Head Master/Mistress

Name Designation:

Official Seal:

Note for the Head of the School

Dear Sir/Madam,

The above mentioned information is required for admission of the candidate in the Jawahar Navodaya Vidyalaya, Shivaragudda. You are therefore requested to kindly check and verify personally all the entries from the school record and issue the certificate given below.

PRINCIPAL.

Jawahar Navodaya Vidyalaya,

Shivaragudda-571419, Mandya

CERTIFICATE BY THE HEAD OF THE SCHOOL

Certified that the information given above is true as per records. It is also certified that Mas./Kum.______was admitted in this School for ______class on ______(date) and passed class V on ______(date).

Signature of the Head Master/Mistress

Date: With office seal.

SOCIO ECONOMIC STATUS OF STUDENTS

1. Name of the Vidyalaya : SHIVARAGUDDA, MANDYA DISTRICT

KARNATAKA STATE-571 419

2. Name of the student :______

3. Father Name :______

4. Mother Name :______

5. Cross(X) the relevant column :

BOY / GIRL
RURAL / URBAN
SC / YES/NO
ST / YES/NO

6. Annual Family income estimated by you:

1. Upto Rs.3000/-
2. Between Rs.3001/- and Rs.6000/-
3. Between Rs.6001/- and Rs.12000/-
4. Between Rs.2001/- and Rs.18000/-
5. Between Rs. 18001/- and Rs. 24000/-
6. Between Rs. 24001/- and Rs.30000/-
7. Between Rs.30001 and Rs.36000/-
8.Between Rs.36001 and Rs.50000/-
9. Above Rs.50000/-

7. Occupation of Parents:

(Make the relevant column and if possible and further description of occupation. More then one column may be marked if necessary e.g. a small agriculturist may also work as a labourer etc.,)

FATHER / MOTHER
1. AGRICUTURIST
2.LABOURER
3.INCUSTRIAL WORKER(organized SECTOR)
4.SELF EMPLOYED(Craftsman etc.,) Give particulars
5. BUSINESS(Give particulars
6. GROUP “D” OR SIMILAR EMPLOYMENT
7. CLERICAL
8.TECHNICIAN
9.PROFESSIONAL
10.MANAGEMENT
11.HOUSE WIFE
12. OTHERS(Specify)

6. EDUCATION:

Category belongs to

FATHER / MOTHER
1. ILLITERATE
2.LITERATE BUT NOT COMPLETED
3. PRIMARY
4.MIDDLE
5. MATRIC/HIGHER SECONDARY
6.GRADUATE(B.Com/B.Sc)
7.POST GRADUATE (M.A./M.COM/M.Sc.)
8.TECHNICAL/PROFESSIONAL/DIPLOMA
9.TECHNICAL/PROFESSIONAL DEGREE

7. Family members (including parents): 4 or less than 4 5 or 6

7 or 8 9 & more than 9

Any siblings (Give sex and age only) who were

1. Of Primary School age (6-11) but not school

2. Of middle school age (12-12) but not school

3. Aged (15-18) but not in school (two children)

ANY SIGLINGS WHO HAVE

Obtained a degree or more:

9. ANY OTHER NOTEWORTHY INFORMATION:

(Record any information about the status of the family which may be interesting or useful to you as Principal.

PRINCIPAL.

JAWAHAR NAVODAYA VIDYALAYA, SHIVARGUDDDA, MADDUR TALUK

MANDYA DISTRICT-571419, KARNATAKASTATE

(Ministry of Human Resource Development, Govt. of India Department of Education)

UNDERTAKING

I ______Father/Guardian of Mas/Kum.______who has been selected for admission to Jawahar Navodaya Vidyalaya, Shivaragudda, Mandya District, hereby given the following undertaking.

That I have read the contents of the information bulletin attached along with the application form, admission to the Jawahar Navodaya Vidyalaya, Shivaragudda, Mandya District in respect of my ward and have been explained to me in vernacular language and I have understood the same.

I have made a declaration in the application form that in the interest of national integration and under the Navodaya Vidyalaya Scheme, a student is transferred from one school to another Jawahar Navodaya Vidyalaya on reaching class IX. I hereby undertake and declare that I shall abide by the said condition if the Navodaya Vidyalaya Scheme and I have no objection if my son/daughter is transferred from the Jawahar Navodaya Vidyalaya to which the admission is granted to any Navodaya Vidyalaya in any other linguistic State/Region as provided in the Scheme.

I further undertake and declare that I shall abide by the aforesaid conditions and if my son/daughter refuses to move to the desired Vidyalaya, he/she will not be allowed to continue to stay in any Jawahar Navodaya Vidyalaya and his/her students would be discontinued and I shall withdraw him/her from this Vidyalaya.

Place:(Name of the father/Guardian)

IN BLOCK LETTER AND ADDRESS

Date:

Signed in my presence.

PRINCIPAL,

JAWAHAR NAVODAYA VIDYALAYA,

SHIVARAGUDDA, MANDYA DISTRICT,

KARNATKA STATE-572 419.

JAWAHAR NAVODAYA VIDYALAYA, SHIVARGUDDDA, MADDUR TALUK

MANDYA DISTRICT-571419, KARNATAKASTATE

(Ministry of Human Resource Development, Govt. of India Department of Education)

MEDICAL FITNESS CERTIFICATE

1. Name of the Candidate :______

2. Father’s Name :______

3. Address :______

______

4. Date of Birth :______

5. Height :______

6. Weight :______

7. Abdomen :______

8. Chest :______

9. Eyes :______

10.Ear :______

11. Throat :______

12. Locomotors system :______

13.State of vaccination :______

14. Skin :______

15. Blood Group :______

15. Remarks of Medical Officer : Recommended/not recommended for

Admission/Recommended to C.M.D. for

Attested photo of the student

Verification of age.

Medical Officer,

(District Civil Surgeon),Mandya.

PRINCIPAL, JNV MANDYA

RESIDENCE CERTIFICATE

(To be furnished by the Parents of the qualified children at the time of admission to JNVs)

As per Jawahar Navodaya Vidyalaya, Mandya District, Karnataka State vide Lr.No.3-20/JNVS/2017-18/ dated______my ward Mast./Kum.______has qualified the Entrance exam for admission to class VI at JNV, Shivaragudda, District Mandya State: Karnataka during the session 2017-18.

I am residing along with my ward mentioned above at the following address since______Years.

Village/Town______Mandal/Tehsil______

District______, State______

Pin Code______

Certified that the information furnished by me is true and no fact has been concealed.

Signature of Parents

Full Name:______

Address______

______

Place:______

Date:______

CERTIFICATE

(To be filled up by the District Authorities and issued under the signature of SDM.Tehsildar to the Parents of the child selected for admission to Class-VI in JNVs through JNVST)

This is to certify that the above information furnished by Shri/Smt.______Father/Mother of Master./Kum.______a candidate selected for admission to class VI in JNV, Shivaragudda, District: Mandya has been verified from the records and is found to be correct. The area where his/her residence is located falls under rural/urban of District:______

Signature

SDM/Tehsildar.

AFFIDAVIT

( An affidavit to be furnished by parents on Rs. 50/- Stamp paper duly attested by notary at the time of admission to class-VI in JNVs through JNVST)

I ______Aged______years, father/Mother of Mast./Kum______Resident of Village______P.O.______Taluk______

District______do hereby solemnly declare and affirm as under.

a)My ward is a student of ______(Name and complete address of the Institution)located in ______which is a rural/Urban area in District: Mandya in Karnataka State since______. He/She has passed Class –V from this Institution during the session 2015-16.

b)My ward is residing with me at the following address______which is located in therural/urban area of District Mandya.

Verified on this ______day of ______2016 at______(Place) that the contents of above affidavit are true to the best of my knowledge and belief based on records and believed by me to be true.

Signature

(DEPONENT)

Name

Place:______

Date:______